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To make informed choices, patients need information about negative as
well as positive effects of treatments. There is little information about
negative effects of psychological interventions.
To determine the prevalence of and risk factors for perceived negative
effects of psychological treatment for common mental disorders.
Cross-sectional survey of people receiving psychological treatment from
184 services in England and Wales. Respondents were asked whether they
had experienced lasting bad effects from the treatment they received.
Of 14 587 respondents, 763 (5.2%) reported experiencing lasting bad
effects. People aged over 65 were less likely to report such effects and
sexual and ethnic minorities were more likely to report them. People who
were unsure what type of therapy they received were more likely to report
negative effects (odds ratio (OR) = 1.51, 95% CI 1.22–1.87), and those
that stated that they were given enough information about therapy before
it started were less likely to report them (OR = 0.65, 95% CI
One in 20 people responding to this survey reported lasting bad effects
from psychological treatment. Clinicians should discuss the potential for
both the positive and negative effects of therapy before it starts.
Concerns have been expressed about the impact that screening for risk of
suicide may have on a person's mental health.
To examine whether screening for suicidal ideation among people who
attend primary care services and have signs of depression increases the
short-term incidence of feeling that life is not worth living.
In a multicentre, single-blind, randomised controlled trial, 443 patients
in four general practices were randomised to screening for suicidal
ideation or control questions on health and lifestyle (trial
registration: ISRCTN84692657). The primary outcome was thinking that life
is not worth living measured 10–14 days after randomisation. Secondary
outcome measures comprised other aspects of suicidal ideation and
A total of 443 participants were randomised to early (n
= 230) or delayed screening (n = 213). Their mean age
was 48.5 years (s.d. = 18.4, range 16–92) and 137 (30.9%) were male. The
adjusted odds of experiencing thoughts that life was not worth living at
follow-up among those randomised to early compared with delayed screening
was 0.88 (95% CI 0.66–1.18). Differences in secondary outcomes between
the two groups were not seen. Among those randomised to early screening,
37 people (22.3%) reported thinking about taking their life at baseline
and 24 (14.6%) that they had this thought 2 weeks later.
Screening for suicidal ideation in primary care among people who have
signs of depression does not appear to induce feelings that life is not
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